79 Renal Cell Carcinoma Among Native American Patients in Oklahoma: A Single-Institution Experience from an NCI-Designated Cancer Center

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Abstract Background Native American (NA) populations in Oklahoma experience disproportionately high incidence (43.7 vs 20.7 per 100,000) and mortality (8.6 vs 4.7 per 100,000) from renal cell carcinoma (RCC) compared with Non-Hispanic White (NHW) populations. However, population-based datasets lack patient-level clinical detail, limiting understanding of outcomes both overall and at academic cancer centers. We characterized disease presentation, treatment patterns, and overall survival (OS) among NA RCC patients treated at Stephenson Cancer Center (SCC), stratified by disease setting, and compared stage-matched outcomes with SEER (Surveillance, Epidemiology, and End Results Program) and Oklahoma registry benchmarks. Methods We conducted a retrospective cohort study of NA patients with RCC treated at SCC between 2003 and 2024. Clinical and demographic data were obtained via EMR review. The cohort was stratified into non-metastatic (Stage I–III) and metastatic (Stage IV) groups, with Stage II/III designated as a high-risk localized subgroup. American Joint Committee on Cancer (AJCC) staging system was used to categorize stage at diagnosis. Population-level benchmarks were obtained from SEER and the Oklahoma Central Cancer Registry (OK2Cancer). OS was analyzed using Kaplan–Meier methods with log-rank testing. Stage-stratified comparisons (localized, regional, distant) were performed against SEER NA benchmarks, and a Cox proportional hazards model, adjusting for age and stage, was used to compare OS between the SCC and SEER cohorts. Results A total of 159 NA RCC cases were included, to our knowledge, representing one of the largest single-institution NA RCC cohorts with patient-level clinical data reported to date. The cohort included 136 non-metastatic (Stage I–III), 13 metastatic (Stage IV), and 10 unstaged patients. Median age at diagnosis was 60 years (range 29–83), with a male preponderance (62.3%) and predominantly clear-cell histology (94.0%). Compared with SEER-reported NA patients, SCC patients were diagnosed at a significantly younger age (60 vs 65 years, p < 0.0001). Among non-metastatic patients, 40.4% had high-risk localized disease (Stage II/III, n = 55). Relative to SEER benchmarks, the SCC cohort had a significantly lower proportion of Stage IV disease at diagnosis (8.2% vs 28.4%, p < 0.0001) and a higher proportion of stage III disease (30.8% vs 9.9% SEER NA). Nephrectomy was performed in 91.8% of patients, and 12% of patients received systemic therapy. Median recurrence-free survival among non-metastatic patients was 162.3 months (5-year RFS: 86.1%).On stage-stratified analysis, SCC NA patients demonstrated significantly improved OS compared with SEER NA benchmarks across all disease settings: localized (log-rank p < 0.0001), regional (log-rank p < 0.0001), and distant (log-rank p < 0.0001). After adjusting for age and stage, SCC patients had a 90% lower hazard of death compared with SEER NA patients (HR 0.100, p < 0.0001). Median travel distance to SCC was 78 miles (range 5.5-255 miles). Conclusions Despite a high burden of locally advanced disease at diagnosis, NA patients with RCC treated at SCC, an NCI-designated tertiary cancer center, demonstrated significantly improved OS compared with population-based benchmarks across all disease stages, even after adjusting for age and stage. Earlier stage diagnosis, high utilization of definitive surgical therapy, and access to specialized multidisciplinary care may contribute to these favorable outcomes, though the retrospective design and potential for racial misclassification in SEER data warrant caution in interpretation. In the context of persistent statewide disparities in RCC incidence and mortality among NA populations, these findings highlight the importance of expanding access to specialized cancer care and reducing geographic barriers to improve outcomes for this underserved population.